Technology Developed: We propose to develop the Intelligent Mobile Antiretroviral Adherence Coach (IMAAC), which is an easy- to-use, mobile software system for enhancing adherence to antiretroviral medication. The IMAAC, which will run on industry standard personal digital assistants (PDAs) and cell phones, combines an adherence knowledgebase founded on cognitive-behavioral principals, intelligent interaction and reasoning capabilities, and a patient model adapted for each individual user. It will learn an individual's behavioral response patterns and provide alternative solutions known to improve or enhance medication adherence. The innovation of this product is its ability to adapt to individual user characteristics and generate personalized intelligent interactive guidance based on cognitive-behavioral principles. This will enhance its utility for long-term maintenance of behavior change. The delivery of the application on standard PDAs and cell phones minimizes costs. It also helps users maintain privacy by not drawing the attention a person may get carrying a specialized device. Phase I efforts will focus on the feasibility and acceptability of the IMAAC. In Phase II, we will fully develop the system and compare its efficacy to a control group of patients receiving standard-of-care. Uses of Technology/Products/Service: At the end of 2005, an estimated 1,205,969 persons in the United States were living with HIV/AIDS. By 1998, the number of patients ever receiving ART increased to 71%, however only 53% of these individuals reported receiving antiretroviral therapy (ART) during a second follow-up interview suggesting that while most individuals receiving care for HIV in the United States have taken ART, continuing its use is problematic for a significant proportion of individuals. This is troubling because there is overwhelming evidence that ART reduces morbidity and mortality associated with HIV/AIDS. Research has found that behavioral interventions are successful at enhancing adherence to complicated antiretroviral medication regimens. One of the reasons behavioral interventions are successful is the feedback and support individuals get while they are engaging in a behavioral intervention along with information and strategies to support lifestyle changes. The problem with previous behaviorally-based programs is that they are time limited, whereas ART adherence is a long-term and life-long endeavor for individuals infected with HIV. Developing an innovative system that is based on cognitive-behavioral principles that can be tailored to an individual so that the program actually adapts to individual changes over time is likely to facilitate and maintain significant adherence among diverse HIV infected populations. Performigence Corporation's technology provides the capability to represent an adherence knowledgebase based on cognitive-behavioral principles and deliver intelligent interaction so that the user's physiological model can be understood and the guidance can be adapted through behavioral and life style intelligence. The IMAAC offers a convenient and sophisticated method for individuals to access empirically validated methods of ART adherence that are continually tailored to their needs and circumstances. Benefit to Company: Once the prototype is developed, Phase II funds will be sought after to complete development and test the efficacy of the system. With Phase I and Phase II funding from the STTR program, Performigence will be able to address ART adherence among HIV-positive individuals with a system that combines portability, intelligent interaction, ease of use, and low cost of consumer electronics with cognitive-behavioral principles. While this system is being designed to improve ART adherence among HIV-positive populations, the public health significance of this project is quite high because this system can be easily modified to address other chronic conditions that rely heavily on lifestyle changes such as diabetes and obesity. Both conditions increase morbidity and mortality across all age and ethnic groups in the United States. How Product Will Be Commercialized: Performigence's proprietary software technology will be used as the foundation for IMAAC development. The system will be sold to medical, industrial, research and consumer markets. It is anticipated that the IMAAC will have widespread uptake and use by consumers as well as physicians. PUBLIC HEALTH RELEVANCE: Developing a system that can be used with hand-held devices like telephones or personal digital assistants (PDAs) that can be tailored to an individual to provide motivational messages, behavioral cues, factual information, interactive guidance and reinforcement would likely increase antiretroviral adherence, thereby reducing morbidity and mortality associated with HIV/AIDS. Additionally, the system would be a cost-effective method to provide information to medical providers to enhance treatment and care. Modifications to such a system could be made to meet the needs of other chronic diseases that require behavioral and lifestyle changes, making the utility of the system wide-ranging.